SRS322 - Choosing between nerve and tendon/muscle transfers for elbow flexion after traumatic brachial plexus injury: a systematic review and narrative synthesis

Abstract Background High-energy traumatic brachial plexus injuries (TBPI) are devastating injuries that often result in loss of elbow flexion, profoundly limiting independence. Restoration is a key surgical priority, but whether nerve transfers (NT) or tendon/muscle transfers (TMT) offer optimal outcomes remains unclear. This review compared NT and TMT outcomes in adults with TBPI. Methods We systematically searched PubMed, EMBASE and Cochrane Library (November2014–2024) for studies comparing these two techniques in adults with TBPI. Primary outcomes were elbow-flexion strength (Medical Research Council [MRC] grade≥3) and range of motion (ROM); secondary outcomes were shoulder abduction and wrist extension. Data were synthesised narratively and pooled means with 95% confidence intervals (c.i.) calculated. Risk of bias was assessed using the Newcastle-Ottawa Scale and GRADE framework. Results Searches revealed 699 papers, of which four retrospective studies met the inclusion criteria (514 patients: 187 NT, 269 TMT). For NT, mean elbow-flexion strength was MRC 3.25 ± 1.21 (c.i. 3.06–3.44) compared to 3.18 ± 1.15 (c.i. 3.03–3.33) for TMT. MRC ≥ 3 was achieved in 55% and 58% patients, respectively. Mean elbow ROM was 98.3 ± 54.3° (c.i. 88.8–107.8) after NT compared to 96.2 ± 46.9° (c.i. 89.9–102.5) after TMT. Shoulder-abduction ROM favored NT (NT: 64.4 ± 48.2° versus TMT: 57.1 ± 46.0°). Wrist-extension data were insufficient. Conclusions Both techniques provide comparable elbow-flexion restoration, but current evidence is limited to small retrospective cohorts. Until larger prospective studies are reported, selection should be individualised. Emerging hybrid approaches may offer added benefit in complex injuries, and this requires further investigation.